| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Christus
| Facility | $3.84 | $3.84 | $30.00 | |
United
| Facility | $100.00 | $100.00 | $100.00 |
Pharmacy - Other Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Christus
| Facility | $3.84 | $3.84 | $30.00 | |
United
| Facility | $100.00 | $100.00 | $100.00 |